Phase 1

An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will review community-level wastewater-based disease surveillance and its potential value toward prevention and control of infectious diseases in the United States. The committee will:

1. Describe wastewater-based disease surveillance and how it differs from other approaches to disease surveillance and other wastewater monitoring for contaminants.
2. Review how wastewater-based surveillance has been useful in understanding COVID-19 in communities and informing local public health decisions.
3. Examine the potential value of specific applications of wastewater-based disease surveillance for understanding and preventing disease and illness beyond COVID-19 and factors that may limit its application in the United States.
4. Describe the general characteristics of a robust, integrated approach for national use of wastewater-based disease surveillance.
5. Discuss broad approaches to increase the public health impact of wastewater surveillance in the United States and the most effective strategies for federal, state, and local coordination to achieve national implementation of wastewater surveillance for an array of diverse infectious disease health indicators.

For the purpose of this study, community-level wastewater-based disease surveillance implies sampling at wastewater treatment plants and does not include local surveillance at neighborhood or institutional scales. To inform the study, the committee will briefly review ongoing and planned U.S. federal, state, local, tribal, and territorial efforts as well as international case examples for implementing wastewater-based disease surveillance. The committee’s report will include conclusions and recommendations on wastewater-based surveillance in federal, state and local public health efforts in the prevention and control of infectious diseases. Applications of wastewater-based surveillance for non-infectious agents, in global settings, and for facility-level surveillance are outside the scope of this review, but the committee may identify these for future evaluation.

Phase 2

The committee will conduct an in-depth study of opportunities and barriers relevant to increasing the use and utility of wastewater surveillance for the prevention and control of infectious diseases in the United States. Specifically, the committee will:

1. Define specific characteristics for development and implementation of a robust, integrated wastewater-based infectious disease surveillance program and discuss technical constraints and opportunities associated with wastewater sampling, testing, and data analysis, including:

• Methods and/or quality criteria, including genomics and sequencing, to detect pathogens, including strain- or variant-specific methods. Methods for discovery of unknown emerging pathogens can also be considered.
• Data reporting, data analysis, and data interpretation for detecting emerging threats to public health and estimating disease incidence and prevalence, including data integration with other surveillance data for improving predictive models.

2. Identify significant technical limitations that could impact the feasibility of using wastewater surveillance as a platform for generating data for indicators of public health status and risk.
3. Describe the research, development, and information sharing needed to meet emerging needs and increase impact of wastewater surveillance for improving public health in the United States.
4. Identify resources for supporting wastewater surveillance.

In addition to its focus on community-level wastewater-based disease surveillance (i.e., with samples taken at a wastewater treatment plant), the committee may also discuss subsewershed sampling that would usefully support a robust, equitable, and sustainable wastewater surveillance program.